Provider Demographics
NPI:1033931654
Name:NOURISH WELLNESS LLC
Entity type:Organization
Organization Name:NOURISH WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:RD, MPH, NBC-HWC
Authorized Official - Phone:646-400-8723
Mailing Address - Street 1:200 N VINEYARD BLVD STE
Mailing Address - Street 2:A325 #1122
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817
Mailing Address - Country:US
Mailing Address - Phone:646-400-8723
Mailing Address - Fax:
Practice Address - Street 1:200 N VINEYARD BLVD STE
Practice Address - Street 2:A325 #1122
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817
Practice Address - Country:US
Practice Address - Phone:646-400-8723
Practice Address - Fax:808-663-0321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty